Study among UK fashion models suggests that body mass index is not a relevant indicator of eating disorder symptomology


While low body mass index (BMI) is often considered an indicator of disordered eating, a study published in Psychiatry Research found no evidence that low BMI was associated with eating disorder symptomology among fashion models and nonmodels.

Fashion models are under persistent pressure to maintain slim, lean figures, placing them at greater risk of developing eating disorders. Study authors Christina Ralph-Nearman and her team say there is a surprising lack of research concerning the health of fashion models.

In an attempt to avoid unhealthily thin bodies being represented in the media, several European countries have adopted a policy called the “Body Image Law.” The law mandates a minimum body mass index (BMI) cut-off that all models must meet to be considered healthy enough to work. Body mass index is a number value that is calculated based on a person’s weight and height measurements and is often used as a health screening measure. However, it remains unclear whether BMI is actually a fitting measure of mental or physical health.

In the first study of its kind, Ralph-Nearman and her colleagues examined the associations between experimenter-measured BMI and eating disorder tendencies among fashion models. The researchers recruited a UK sample of 67 professional female fashion models who were between the ages of 18 and 35, and 218 female nonmodels who were between the ages of 18 and 37.

All paricipants completed the Eating Disorder Examination Questionnaire (EDE-Q 6.0), an evaluation of disordered eating that assesses the frequency of certain eating disorder behaviors in addition to several components of eating disorder symptomology. Experimenters then obtained participants’ height and weight measurements to calculate their BMI scores.

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After controlling for age, the fashion models showed greater eating restraint behavior, slightly greater fear of gaining weight, slightly more negative feelings about eating, and somewhat higher global EDE-Q scores. The models also showed greater laxative misuse while nonmodels showed more binge eating accompanied by feelings of loss of control.

Interestingly, of the 22 participants (both models and nonmodels) who met the cut-off for clinically significant disordered eating, only one of them had a BMI score that fell below the suggested cut-off of 18.5 or 18. The 21 other women with significantly disordered eating had BMI scores that were above this cut-off. Moreover, among the subgroup of participants with “healthy” BMI scores (within the range of 18.6–22.7), a higher BMI was actually linked to higher scores on the EDE-Q. For those with “unhealthy” BMI scores (less than 18.5), this association was not found.

These findings imply that BMI is not a reliable measure of eating disorder symptomology, at least not on its own. The results also suggest a disturbing possibility — fashion models who present with eating disorder symptoms but who have a BMI score within the normal range are likely being overlooked. In line with this rationale, past studies suggest that patients with anorexia nervosa can regain a healthy BMI while still presenting with all other criteria of an eating disorder.

The researchers note that imposing a BMI cut-off for fashion models could also send the harmful message to the public that all slim bodies are unhealthy bodies — the inverse of the notion that all larger bodies are unhealthy bodies. A BMI cut-off could also promote an increased focus on weight monitoring among fashion models, potentially increasing their risk of developing eating disorder tendencies.

The study’s authors suggest alternative ways to encourage healthy body sizes in the media, including, “mandating that designers produce a wider range in sample clothing sizes to be inclusive of a range of body sizes for their runway shows, photo shoots, and advertisements.” As far as protecting the health of fashion models, Ralph-Nearman and her colleagues recommend “less invasive and implicit detection of eating disorder symptoms, and immediate referral to a clinician when needed, as well ensuring that there is access to appropriate treatment and support for high-risk models.”

The study, “What is the relationship between body mass index and eating disorder symptomatology in professional female fashion models?”, was authored by Christina Ralph-Nearman, Hung-wen Yeh, Sahib S. Khalsa, Jamie D. Feusner, and Ruth Filik.


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